Rose P G, Baker S, Kern M, Fitzgerald T J, Tak W K, Reale F R, Nelson B E, Hunter R E
Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester 01655.
Int J Radiat Oncol Biol Phys. 1993 Oct 20;27(3):585-90. doi: 10.1016/0360-3016(93)90383-7.
Primary radiation therapy is generally considered inferior to a surgical approach for patients with endometrial carcinoma and is reserved for patients with a high operative risk. These patients are usually elderly, have multiple medical problems and frequently die of intercurrent disease. To evaluate the efficacy of primary radiation therapy a case controlled analysis comparing corrected survival of patients treated with primary radiation to patients treated with surgical therapy with or without radiation therapy was performed.
Sixty-four patients treated with primary radiation therapy were retrospectively studied. A Kaplan-Meier product limit survival analysis was used to estimate survival among patients treated with primary radiation therapy. A case control study matched by clinical stage, tumor grade, and time of diagnosis was performed. The Mantel-Cox statistic was used to evaluated the equality of the survival curves.
Primary radiation therapy was used to treat 9.0% of the patients with endometrial carcinoma during the study period. Cardiovascular disease, diabetes, age greater than 80 and morbid obesity were the most common indications. Ninety percent of patients had either Stage I or II disease. Forty-eight of the 64 patients (75%) completed treatment which included both teletherapy and brachytherapy. Ten patients received brachytherapy only. Twelve complications, both acute and chronic, occurred in eleven patients (17%). Intercurrent disease accounted for 13 of the 36 (36%) of the deaths. Clinical stage of disease and histologic grade of the tumor were significant predictors of survival, p = 0.0001 and p = 0.013, respectively. The case controlled study of Stage I and II patients treated by primary radiation therapy matched to surgically treated controls showed no statistical difference in survival. Dilatation and curettage after the completion of radiation therapy was predictive of local control, p = 0.003.
Although surgery followed by tailored radiation therapy has become widely accepted therapy for Stage I and II endometrial carcinoma, even in patients who are a poor operative risk, the survival with primary radiation therapy is not statistically different.
对于子宫内膜癌患者，原发性放射治疗通常被认为不如手术治疗，仅适用于手术风险高的患者。这些患者通常年事已高，有多种内科疾病，且常死于并发疾病。为评估原发性放射治疗的疗效，进行了一项病例对照分析，比较接受原发性放射治疗患者与接受手术治疗（无论是否联合放射治疗）患者的校正生存率。
对64例接受原发性放射治疗的患者进行回顾性研究。采用Kaplan-Meier乘积限界生存分析来估计接受原发性放射治疗患者的生存率。进行了一项按临床分期、肿瘤分级和诊断时间匹配的病例对照研究。采用Mantel-Cox统计量评估生存曲线的一致性。
在研究期间，原发性放射治疗用于治疗9.0%的子宫内膜癌患者。心血管疾病、糖尿病、年龄大于80岁和病态肥胖是最常见的适应证。90%的患者患有I期或II期疾病。64例患者中有48例（75%）完成了包括远距离放疗和近距离放疗的治疗。10例患者仅接受了近距离放疗。11例患者（17%）出现了12例急慢性并发症。并发疾病占36例死亡中的13例（36%）。疾病的临床分期和肿瘤的组织学分级是生存的显著预测因素，p值分别为0.0001和0.013。对接受原发性放射治疗的I期和II期患者与手术治疗对照进行的病例对照研究显示，生存率无统计学差异。放射治疗完成后进行刮宫术可预测局部控制情况，p = 0.003。
尽管手术后进行个体化放射治疗已成为I期和II期子宫内膜癌广泛接受的治疗方法，即使是手术风险高的患者，原发性放射治疗的生存率在统计学上并无差异。
